On April 21 Rep. Louise McIntosh Slaughter (D-NY), moderated a press conference held by the bi-partisan Pro-Choice Congressional Caucus for the introduction of a new bill —"Putting Prevention First-HR 4192." There are 106 co-sponsors. The Senate version, S 2336, is sponsored by Sen. Harry M. Reid (D-NV) and has eight Senate co-sponsors.

Throughout its seven titles, the bill's purpose is "to expand access to preventive health care services and education programs that help reduce unintended pregnancy, reduce infection with sexually transmitted disease, and reduce the number of abortions."

"Improving women's health and reducing unintended pregnancies are goals that everyone in Congress can agree on," said Rep. Slaughter. "One's views on abortion are irrelevant - we all agree that women should have access to quality health care, and that we need to decrease the number of abortions and STD infections in this nation*.This measure provides sensible solutions that we know will work to reduce unintended pregnancies, protect women's health and give women the tools they need to make the best decisions possible for themselves. It's time to stop playing politics with women's health, and time to start showing the women and girls of this nation that we respect them, their health, and their futures."

Background and Talking Points

While researching information for this bill, the Congressional members determined that:

(1) Although the Centers for Disease Control and Prevention (CDC) included family planning in its published list of the 'Ten Great Public Health Achievements in the 20th Century', the United States still has one of the highest rates of unintended pregnancies among industrialized nations.

(2) Each year, three million pregnancies, nearly half of all pregnancies in the United States, are unintended; and half of unintended pregnancies end in abortion.

(3) In 2000, 34 million women-half of all women of reproductive age (ages 15-44)-were in need of contraceptive services and supplies to help prevent unintended pregnancy, and half of those were in need of public support for such care.

(4) The United States also has the highest rate of infection with sexually transmitted diseases (STDs) of any industrialized country: in 2000 there were approximately 18.9 million new cases of STDs.

(5) Increasing access to family planning services will improve women's health and reduce the rates of unintended pregnancy, abortion, and infection with STDs. Contraceptive use saves public health dollars: every dollar spent on providing family planning services saves an estimated $3 in expenditures for pregnancy-related and newborn care for Medicaid alone.

(6) Contraception is basic health care that improves the health of women and children by enabling women to plan and space births.

(7) Women experiencing unintended pregnancy are at greater risks for physical abuse and women having closely spaced births are at greater risk of maternal death.

(8) The child born from an unintended pregnancy is at greater risk of low birth weight, dying in the first year of life, being abused, and not receiving sufficient resources for healthy development.

(9) The ability to control fertility also allows couples to achieve economic stability by facilitating greater educational achievement and participation in the workforce.

(10) The average American woman desires two children and spends five years of her life pregnant or trying to get pregnant and roughly 30 years trying to prevent pregnancy; without contraception, a sexually active woman has an 85 percent chance of becoming pregnant within a year.

(11) Many poor and low-income women cannot afford to purchase contraceptive services and supplies on their own. More than 12 million, or 20 percent of all women aged 15-24, were uninsured in 2002, and that proportion has increased by 10 percent since 1999.

(12) Public health programs like Medicaid and Title X, the national family planning program, provide high-quality family planning services and other preventive health care to underinsured or uninsured individuals who may otherwise lack access to health care.

(13) Medicaid is the single largest source of public funding for family planning services and HIV/AIDS care in the United States. Half of all public dollars spent on contraceptive services and supplies in the United States are provided through Medicaid, and approximately 5.5 million women of reproductive age-nearly one in 10 women between the ages of 15 and 44-rely on Medicaid for their basic health care needs.

(14) Each year, Title X services enable Americans to prevent approximately one million unintended pregnancies, and one in three women of reproductive age who obtains testing or treatment for STDs does so at a Title X-funded clinic. In 2002, Title X-funded clinics provided three million Pap tests, 5.2 million STD tests, and 494,000 HIV tests.

(15) The increasing number of uninsured, stagnant funding, health care inflation, new and expensive contraceptive technologies, and improved but expensive screening and treatment for cervical cancer and STDs, have diminished the ability of Title X funded clinics to adequately serve all those in need. Taking inflation into account, funding for the Title X program declined 57 percent between 1980 and 2003.

(16) While Medicaid is the largest source of subsidized family planning services, many States have had to make significant cuts in their Medicaid programs due to budget pressures putting many women at risk of losing coverage for family planning services.

(17) In addition, eligibility for Medicaid in many States is severely restricted leaving family planning services financially out of reach for many poor women. Many States have demonstrated tremendous success with Medicaid family planning waivers that allow them to expand access to Medicaid family planning services. However, the administrative burden of applying for a waiver poses a significant barrier to States that would like to expand their Medicaid family planning programs.

(18) Many private health plans still do not cover contraceptive services and supplies. The lack of contraceptive coverage in health insurance plans places many effective forms of contraception beyond the financial reach of many women.

(19) Including contraceptive coverage in private health care plans saves employers money: not covering contraceptives in employee health plans costs employers 15 to 17 percent more than providing such coverage.

(20) Emergency contraception is a safe and effective way to prevent unintended pregnancy after unprotected sex. It is estimated that the use of emergency contraception could cut the number of unintended pregnancies in half, thereby reducing the need for abortion.

(21) In 2000, 51,000 abortions were prevented by use of emergency contraception; increased use of emergency contraception accounted for up to 43 percent of the total decline in abortions between 1994 and 2000.

(22) Access to comprehensive sex education is critical to reducing rates of unintended pregnancy, abortion, and STD infection among teens. Over 60 percent of teens have had sex before they graduate from high school and nine out of 10 people have sex before they get married. 822,000 teenagers become pregnant each year; 35 percent of teen girls become pregnant at least once before turning 20; and 78 percent of teenage pregnancies are unintended. Nearly half (48 percent) of new STD cases are among people ages 15-24, even though these youth make up only a quarter of the sexually active population.

(23) The American Medical Association, the American Nurses Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Public Health Association, and the Society for Adolescent Medicine, support responsible sexuality education that includes information about both abstinence and contraception.

(24) Comprehensive sex education protects adolescent health. A recent survey found that only 15 percent of American parents believe that schools should just teach about abstinence.

(25) A recent study showed that teens who took pledges to remain virgins until marriage were just as likely to contract STDs as teens who did not take virginity pledges and that although teens taking the pledges delayed sexual debut, they were less likely to use condoms once they were sexually active.

(26) Teens who receive sex education that includes discussion of contraception are more likely than those who receive abstinence-only messages to delay sex and to have fewer partners and use contraceptives when they do become sexually active.

Summary of the Titles

The "Putting Prevention First Act" has been referred to as an omnibus bill, because it has pulled together several separate pieces of legislation, each of which was designed to prevent unintended pregnancies. The pro-choice Caucus Press Release summarized the seven titles as follows:

Title I: Title X of the Public Health Service Act: Increases funding for Title X of the Public Health Service Act by $365 million, from $278 million in FY 04 to $643 million in FY 05. Title X clinics provide a variety of health services to women, including programs to reduce sexually transmitted diseases (STDs) and detect breast and cervical cancer.

Title II: Family Planning State Empowerment (S 1429): Allows states to expand Medicaid family planning services to women with incomes up to 200 percent of the federal poverty level, without having to apply to the federal government for a waiver.

Title III: Equity in Prescription Insurance and Contraceptive Coverage (HR 2727/S 1396): Requires private health plans to cover FDA-approved prescription contraceptives and related medical services to the same extent that they cover prescription drugs and other outpatient medical services.

Title IV: Emergency Contraception Education and Information (HR 1812/S 896): Provides $10 million to implement important public education initiatives about emergency contraception (EC) and its benefits and uses to both women and medical providers.

Title V: Compassionate Assistance for Rape Emergencies (HR 2527): Requires that hospitals receiving federal funds promptly provide EC upon patient request, in addition to medically, factually accurate and unbiased written and oral information about EC to women who survive sexual assault.

Title VI: Family Life Education: (107th Congress - HR 3469): Provides $100 million in annual funding to states to support comprehensive sex education that includes information about both abstinence and contraception.

Title VII: Teenage Pregnancy Prevention (107th Congress - HR 3581): Provides $20 million in annual funding for competitive grants to public and private entities to establish or expand teen pregnancy prevention programs.

Suggested Action

These bills were introduced in conjunction with the April 25th Historic March for Women's Lives with an estimated 1,150,000 women and men in attendance on the Washington Mall. It is thought to have been the largest justice march ever in the history of Washington marches.

The bills remain in Committees of both the House and the Senate.

Advocates are encouraged to contact their Senators and Representative on the total bill, but it is possible to pick one or two of the titles alone. The 26 points in the Background and Talking Points section (above) can serve as a resource for letters or e-mails to Congress, newspaper letters to the editor or adult education classes in your churches.

Write: The Honorable_________
U.S. Senate
Washington, D.C. 20510

Write: The Honorable_________
U.S. House of Representatives
Washington, D.C. 20515

Call the Capitol Switchboard at (202) 224-3121.

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General Assembly Policy

1993 Statement - PC(USA), p. 935

. . . the 205th General Assembly (1993) . . .

1. Support[s] the new Secretary of Health and Human Services in planning for contraceptive research and programs of family planning education, outreach, and services to be offered without cost to anyone who states a need for such assistance;

2. Call[s] upon Congress to vote for prompt funding of a comprensive family planning program that will be offered without cost to any man or woman who states a need; and

3. Call[s] upon Congress and the president to include comprehnsive family planning in any proposal for national health care.

1998 Statement - PC(USA), p. 743

The 210th General Assembly (1998) [of the Presbyterian Church (U.S.A.)]:

1. Request[s] the Stated Clerk of the General Assembly to make clear our support of the Equity in Prescription and Contraceptive Coverage Act (S766 and HR 2176) prior to the fall session of Congress by sending letters of support of Congress members, House and Senate leadership, and the President of the United States; and

2. Encourage[s] Presbyterians to contact their Congressmembers in support of this measure.